K123 – Second day following the hospital assessment
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Developmental and/or behavioural care are services encompassing any combination or form of assessment and treatment by a paediatrician for mental illness, behavioural maladaptations, developmental disorders, and/or other problems that are assumed to be of a developmental or emotional nature where there is consideration of the patient's biological and psychosocial functioning. Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements. In addition to the - common elements, this service includes the following specific elements: - Performing the appropriate therapy or interaction with the patient(s) or the patient's relative(s) or patient's representative. - Performing any procedure(s) during the same encounter as the therapy or other interaction unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with the therapy or interaction. - Making arrangements for any related assessments, procedures, or therapy. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results of related procedure(s) and/or assessment(s). - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is rendered. - Providing premises, equipment, supplies, and personnel for the specific elements of the service.
When to Use
- Use for the second consecutive day of inpatient developmental or behavioural assessment following the initial assessment (K122) for a paediatric patient.
- Use when providing ongoing therapeutic intervention or complex behavioural management for a paediatric patient admitted for developmental concerns where the service exceeds the scope of a standard subsequent visit (C002).
Common Pitfalls
- Billing K123 on the same day as a consultation or assessment by the same physician without distinct, separate diagnoses, which triggers automatic rejection.
- Failing to document the exact start and end times in the chart, which is a mandatory requirement under GP7 for time-based codes.
- Attempting to claim the focused practice psychotherapy premium on K123, which is explicitly excluded by the Schedule of Benefits.
Billing Tips
- Ensure the service duration meets the 'major part thereof' threshold (at least 16 minutes) to justify the unit, as K123 is strictly time-dependent.
- If the patient's condition requires less intensive management than K123, consider billing a standard subsequent visit (C002) to avoid audit scrutiny regarding the complexity of developmental care.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
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